Intervention linked to reduced prescribing for respiratory infections
A provider-focused antibiotic stewardship intervention was associated with reduced antibiotic prescribing for respiratory tract infections (RTIs) at 31 primary care practices, with no impact on prescribing for infections that require antibiotics, researchers reported today in Clinical Infectious Diseases.
The intervention, implemented in the University of Pennsylvania Healthcare System in October 2017, consisted of a one-time educational session on appropriate prescribing for RTIs and patient communication strategies, along with monthly electronic feedback to providers on their prescribing performance for respiratory tract diagnoses (RTDs). Feedback was based on metrics that grouped RTDs into three tiers of appropriateness: tier 1 (antibiotic almost always indicated), tier 2 (may be indicated), and tier 3 (rarely indicated).
To assess the impact of the intervention, researchers conducted a stepped-wedge cluster randomized study comparing the proportion of patient visits with antibiotic prescriptions before and during the intervention.
Across 30 practices and 185,755 unique office visits, the proportion of visits with an antibiotic prescription declined from 35.2% pre-intervention to 23% during the intervention period. In a multivariable analysis, the intervention was associated with reduced odds of antibiotic prescribing for tier 2 diagnoses (odds ratio [OR], 0.57; 95% confidence interval [CI], 0.52 to 0.62) and tier 3 diagnoses (OR, 0.57; 95% CI, 0.53 to 0.61), but not for tier 1 diagnoses (OR, 0.98; 95% CI, 0.83 to 1.16).
"This differential impact suggests that the study intervention was able to reduce inappropriate antibiotic prescribing without adversely impacting appropriate prescribing," the authors wrote. They add that assessing the sustainability of the intervention, along with patient outcomes and any unintended negative outcomes, will be important.
Jul 2 Clin Infect Dis abstract
Antibiotic sales increased during India's first COVID wave
India saw a significant increase in sales of non–child-appropriate formulation (CAF) antibiotics during the first wave of the COVID-19 pandemic, Indian researchers reported yesterday in PLOS One.
Using an interrupted time series (ITS) design, the researchers examined sales volumes of total antibiotics, azithromycin alone, and hydroxychloroquine in India's private sector from January 2018 to December 2020. They focused on non-pediatric formulations and adjusting to seasonal and non-seasonal trends as well as the effects of the lockdown.
India's unregulated private sector accounts for 75% of healthcare delivery and 90% of antibiotic sales in the country, leading to speculation that the surge in patients seeking care for COVID-19 may have led to increased sales of antibiotics, particularly azithromycin, which was being used in combination with hydroxychloroquine in many countries during the early months of the pandemic.
More than 16.2 million doses of antibiotics were sold in India in 2020, which is slightly less than the amount in 2018 and 2019. But the proportion of non-CAF antibiotics rose from 72.5% in 2019 to 76.8% in 2020, and the ITS analysis found that COVID-19 likely contributed to 216.4 million excess doses of non-CAF antibiotics and 38 million excess doses of non-CAF azithromycin from June through September 2020 (after the lockdown and until the first wave peak).
The study authors say the findings have important implications for global antimicrobial resistance, particularly in low- and middle-income countries (LMICs), where overuse of antibiotics is common and similar patterns of antibiotic use among presumptive or confirmed COVID-19 cases likely exist. They also note that if antibiotic use followed the same pattern during India's second wave of COVID-19, which was substantially more devastating, the impact could be even worse.
"Policy makers in India and other LMICs should recognize this substantial overuse of antibiotics induced by COVID-19," they wrote. "Considering the ongoing trends, the very low vaccination coverage level, and the amount of time necessary to eventually vaccinate the entire population, immediate action is needed to reduce the overuse of antibiotics for COVID-19."
Jul 1 PLOS One study